AIM: The purpose of this study was to compare sex differences of atrial fibrillation (AF) catheter ablation (CA) and to analyse the opportunities for improved outcomes. METHODS AND RESULTS: All data were collected from the Atrial Fibrillation Ablation Long-Term registry, a prospective, multinational study conducted by the ESC-EORP European Heart Rhythm Association (EHRA) under the EURObservational Research Programme (ESC-EORP). A total of 104 centres in 27 European countries participated. Of 3593 included patients, 1146 (31.9%) were female. Female patients were older (61.0 vs. 56.4 years; P < 0.001), had more comorbidities (hypertension, diabetes, and obesity), more episodes of arrhythmias per month (6.9 vs. 6.2; P < 0.001), and a higher average EHRA score (2.6 vs. 2.4; P < 0.001). The duration of the procedure was shorter in females (160.1 min vs. 167.9 min; P < 0.001), irrespective of additional ablation lesions added to pulmonary vein isolation. Overall cardiovascular complications were more frequent in women than in men (5.7% vs. 3.4%; P < 0.001). Furthermore, cardiac perforations (3.8% vs. 1.3%; P = 0.011) and neurological complications (2.2% vs. 0.3%; P = 0.004) were found in females in less experienced centres than in experienced ones. On a final note, at 12 months, AF recurrence rate was similar in females and males (34.4% vs. 34.2%; P = 0.897), but more females were still on antiarrhythmic drugs (50.6% vs. 44.1%; P < 0.001) when compared with men. CONCLUSION: Females underwent CA procedures for AF less frequently than males throughout Europe, despite more recurrent symptoms. With the same success rate, severe acute complications remained considerable in females, especially in less experienced centres.

Cardiology Department Fundación Jiménez Díaz Quirón Salud Madrid Spain

Cardiology Department Institute for Clinical and Experimental Medicine Prague Czech Republic

Cardiology Department University of Groningen University Medical Center Groningen Thoraxcenter Groningen The Netherlands

Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Madrid Spain

Department of Cardiology and Medical Science Uppsala University Uppsala Sweden

Department of Cardiology Cardiovascular Institute Hospital Clínic Pediatric Arrhythmia Unit Hospital Sant Joan de Déu University of Barcelona Villarroel 170 Barcelona Spain

Department of Cardiology SMDZ in Zabrze Medical University of Silesia Katowice Silesian Centre for Heart Diseases Zabrze Poland

Department of Electrophysiology Cardiovascular Diseases Institute Iasi Romania

Department of Electrophysiology Heart Center Leipzig University of Leipzig Leipzig Germany

E Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation Rechkunovskaya 15 Novosibirsk Russia

Erasmus Medical Center Clinical Electrophysiology Rotterdam The Netherlands

EURObservational Research Programme European Society of Cardiology Sophia Antipolis France

IDIBAPS Institut d'Investigació August Pi i Sunyer Barcelona Spain

Maria Cecilia Hospital GVM Care and Research Cotignola Italy

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